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General NPI Number Information
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NPI Number | 1417280892
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Entity Type | Organization
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Legal Business Name | BRIGHTER FUTURES THERAPEUTIC LEARNING CENTER
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 09/16/2009
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Provider Practice Location Address
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Address Line | 4715 YOSEMITE BOULEVARD
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City | MODESTO
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State | CA
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Zip | 95357
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Country | US
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Telephone | 209-574-9707
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Fax | 209-574-9587
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Provider Business Mailing Address
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Address Line | PO BOX 1396
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City | EMPIRE
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State | CA
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Zip | 95319-1396
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Country | US
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Telephone | 209-574-9707
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Fax | 209-574-9587
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | LUCINDA LEANN ANDERSON
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Credential | OTR
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Telephone | 209-574-9707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT 5534
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License Number State | CA
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